Вы находитесь на странице: 1из 1

PROXY FOR THE ORGANIZING MEETING OF THE STATE CENTRAL COMMITTEE OF THE AMERICAN INDEPENDENT PARTY OF CALIFORNIA ON AUGUST

12, 2012, IN SACRAMENTO, CALIFORNIA


I, __________________________________________, duly qualified as a member of the State Central Committee of the American Independent Party, do hereby designate first Edward C. Noonan, and if he is not present, Justin Noonan, who are both registered to vote in California as American Independents, as my proxy with full power to act for me in every respect at the above specified meeting of the State Central Committee. I am a member of the American Independent Party State Central Committee, because I was elected to be one of its National Committeemen. I __________________________________________, (Print, DO NOT SIGN HERE) do declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. Signature: ________________________________________ (Sign. DO NOT PRINT!) Executed at _________________________________________ (City, State or County, State) Date: ______________________

Вам также может понравиться